Provider Demographics
NPI:1891823266
Name:GEORGE, ATHANASIUS DEMOSTHENES (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIUS
Middle Name:DEMOSTHENES
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 SPARTAN RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3029
Mailing Address - Country:US
Mailing Address - Phone:301-570-3755
Mailing Address - Fax:
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1215
Practice Address - Country:US
Practice Address - Phone:301-916-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056274207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483373OtherMAMSI MDIPA OPTIMUMCHOICE
MD08-01568OtherUNITED HEALTHCARE
MD0G90ADOtherCAREFIRST BCBS
DCF911-0001OtherCAREFIRST BCBS
MDG01636Medicare PIN
MD08-01568OtherUNITED HEALTHCARE